By Elizabeth Cerceo, MD, FACP
Fall brings more than flu season – it’s also pneumonia season, also called community acquired bacterial pneumonia (CABP) when the illness occurs in a non-hospital (or institutional) setting.
CABP is the most frequently treated infectious disease in the U.S; In the US, an estimated 5 to 10 million cases of CAP are diagnosed annually and as many as 1.1 million patients are hospitalized each year Older adults are at greater risk for pneumonia as well as its more severe complications than younger populations
What causes pneumonia?
Pneumonia is an infection in one or both of the lungs and can be caused by bacteria, viruses, and fungi. Community-acquired pneumonia (CAP) is the most common type of pneumonia and it occurs outside of hospitals and other health care settings. Most people get CAP by breathing in germs (especially while sleeping) that live in the mouth, nose, or throat. Most cases occur during the winter but pneumonia can happen year-round. About 4 million people get this form of pneumonia each year. About 1 out of every 5 people who has CAP needs to be treated in a hospital.
Bacteria are the most common cause of pneumonia in adults. Some people, especially the elderly and those who are disabled, may get bacterial pneumonia after having the flu or even a common cold. Many types of bacteria can cause pneumonia. Bacterial pneumonia can occur on its own or develop after you’ve had a cold or the flu.
Get diagnosed, Get treated!
While pneumonia may present with classic symptoms of fever, chills, shortness of breath, and a productive cough, the infection can masquerade as chest pain, nausea or vomiting, fatigue, muscle pain, rapid breathing, enlarged lymph nodes in the neck, or sore throat. Many of the symptoms overlap with the common cold but severe symptoms, confusion, low blood pressure, severe shortness of breath or wheezing, and bluish lips or fingers actually could signal more serious pneumonia and warrant a doctor’s appointment.
Treatment challenges
Antibiotics have been used for the last 70 years to treat patients who have infectious diseases — greatly reducing illness and death from infectious diseases. However, these drugs have been used so widely and for so long that the bacteria these drugs are designed to kill have adapted to them, making the drugs less effective. Macrolides, like azithromycin or clarithromycin, are antibiotics commonly used to treat Streptococcus pneumoniae, the primary cause of pneumonia. Bacteria are increasingly resistant to these drugs, yet this class of antibiotic remains among the most commonly prescribed CABP both in the hospital and community settings. Similarly many other overused antibiotics such as fluoroquinolones have seen increases in resistance patterns. This means newer antibiotics are needed and we need to be more judicious with the ones we have.
There are new antibiotics under evaluation by the FDA. One of these, solithromycin, has the potential to treat pneumococcal pneumonia, including antibiotic resistant cases of the disease, and is being studied for both oral and intravenous administration.
Reduce your risk for pneumonia this season
Ask your doctor about getting vaccinated against influenza and pneumococcal disease. There are two current for pneumococcal disease, called Prevnar 13 and Pneumovax. The different vaccines and vaccination schedules may be recommended based on other conditions you may have.
You can protect yourself and your community
Getting vaccinated protects you and your loved ones by preventing against the spread of disease, especially since some people including the very young, the very old, and anyone with severe comorbidities cannot be vaccinated and are vulnerable.
With the looming specter of antibiotic drug resistance, we need to carefully steward the antibiotics that still work. You can help with this. Take antibiotics as directed and complete the whole course; don’t skip doses because bacteria can figure out how to build resistance to antibiotics they have been exposed to before. Also, follow your physician’s instructions. Antibiotics are not a panacea so don’t ask for antibiotics for every ailment. They only should be used in certain settings and never for viral infections.
Elizabeth Cerceo, MD, FACP, is an Assistant Professor, Division of Hospital Medicine and Associate Program Director of the Internal Medicine Residency, Cooper Medical School of Rowan University.
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